Sex Differences in Coronary Artery Calcium and Mortality from Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults with Diabetes: The Coronary Calcium Consortium

Objective: While diabetes mellitus (DM) has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared to men, it is not clear if this still the case. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in persons with DM; however, its sex-specific impact is less defined. We compared the relation of CAC in women versus men with DM for total, CVD, and CHD mortality.

Research Design and Methods: We studied adults with DM from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality endpoints.

Results: Among 4,503 adults with DM (32.5% women) aged 21-93 years, 61.2% of women and 80.4% of men had CAC>0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC>100. Age and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total (1.36 vs. 1.21) and CVD mortality (1.67 vs. 1.33) (interaction p=0.01 for both) but similar for CHD mortality (1.53 and 1.48). For CVD mortality, HR’s with CAC scores of 101-400 and >400 were 3.67 and 6.27, respectively for women and 1.63 and 3.48, respectively for men (interaction p=0.04). For total mortality HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction p=0.01).

Conclusion: CAC predicts CHD, CVD, and all-cause mortality in patients with DM; however, greater CAC predicts CVD and total mortality more strongly in women.